An international comparative family medicine study of the Transition Project data from the Netherlands, Malta, Japan and Serbia. An analysis of diagnostic odds ratios aggregated across age bands, years of observation and individual practices

Soler, Jean Karl; Okkes, Inge; Oskam, Sibo; Boven, Kees van; Zivotic, Predrag; Jevtic, Milan; Dobbs, Frank; Lamberts, H

doi:10.1093/fampra/cmr100

Cited by 12 publications

(20 citation statements)

References 16 publications

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“…The RfE should be recognised by the patient as an acceptable description of the demand for care. 4,14,15 FDs recording data for the Transition Project were trained to record RfEs according to the definitions above and the recommendations in the ICPC book, 4 Japan (1996Japan ( -1998. The practice populations in the Netherlands, Serbia and Japan represent registered patient populations (only those over 15 years of age in Serbia), whereas the population in Malta represents patients consulting over a fiveyear period.…”

Section: Methodsmentioning

confidence: 99%

“…We aggregated or pooled LR values across practices, as we have done in previous studies. 14,15 It would be possible to analyse such relationships between all possible combinations of episode titles and RfEs, using the Transition Project databases. 8,10 The analysis was limited to two selected RfE examples for practical reasons.…”

Section: Methodsmentioning

confidence: 99%

“…1,[14][15][16][17] Cut-off levels of > 2 for the LR of a positive association and < 0.5 for the LR of a negative association, were thus taken as minimum thresholds for clinical significance. [18][19][20][21][22][23][24][25] LRs outside these limits were considered clinically insignificant.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, as above, LRs which were not at least as large as their 95% CI were considered unreliable. 1,[15][16][17]26 Furthermore, LRs based on cells with very small numbers were ignored. These criteria adjust for the increased chance of describing spurious associations due to the large numbers of repeated statistical tests in this analysis process, and also for the effect of clustering of data on estimates of variance.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, the congruency (and often statistical consistency) of diagnostic associations between these populations, and especially the fact that most of them are in the same direction from unity, sustain our confidence in their validity. 14,15 Additionally, the fact that we also present incidence and prevalence rates in these populations allows one to calculate prior and posterior probabilities for these diagnostic entities.…”

Section: Comparisons With the Literaturementioning

confidence: 99%

See 4 more Smart Citations

The interpretation of the reasons for encounter 'cough' and 'sadness' in four international family medicine populations

Soler¹,

Okkes²,

Oskam³

et al. 2013

Journal of Innovation in Health Informatics

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Background This is a study of the relationships between common reasons for encounter (RfEs) and common diagnoses (episode titles) within episodes of care (EoCs) in family practice populations in four countries. Method Participating family doctors (FDs) recorded details of all their patient contacts in an EoC structure using the International Classification of Primary Care (ICPC), including RfEs presented by the patient, and the FDs' diagnostic labels. The relationships between RfEs and episode titles were studied using Bayesian methods.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Comparisons With the Literaturementioning

confidence: 99%

See 3 more Smart Citations

The interpretation of the reasons for encounter 'cough' and 'sadness' in four international family medicine populations

Soler¹,

Okkes²,

Oskam³

et al. 2013

Journal of Innovation in Health Informatics

View full text Add to dashboard Cite

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An international comparative family medicine study of the Transition Project data from the Netherlands, Malta and Serbia. Is family medicine an international discipline? Comparing diagnostic odds ratios across populations

Soler¹,

Okkes

Oskam

et al. 2012

Family Practice

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ICPC, the RfE and the EoC data model are appropriate tools to study the process of diagnosis in FM. Distributions of diagnostic associations between RfEs and episode titles in the Transition Project international populations show remarkable similarities and congruencies in the process of diagnosis from both the RfE and the episode title perspectives. The congruence of diagnostic associations between populations supports the use of such data from one population to inform diagnostic decisions in another. Differences in the magnitude of such diagnostic associations are significant, and population-specific data are therefore desirable. We propose that both an international (common) and a local (health care system specific) content of FM exist and that the empirical distributions of diagnostic associations presented in this paper are a reflection of both these effects. We also observed that the frequency of exposure to such diagnostic challenges had a strong effect on the confidence intervals of diagnostic ORs reflecting these diagnostic associations. We propose that this constitutes evidence that expertise in FM is associated with frequency of exposure to diagnostic challenges.

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Reasons for encounter and symptom diagnoses: a superior description of patients' problems in contrast to medically unexplained symptoms (MUS)

Soler¹,

Okkes

2012

Family Practice

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This is a review of the literature on the role of symptoms in family practice, with a focus on the diagnostic approach in family medicine (FM). We found two, contrasting, approaches to reducing symptoms presented by patients in primary care, especially those which do not immediately allow the definition of a disease-label diagnosis. Years of research into 'medically unexplained symptoms' (MUS) has failed to support an international body of knowledge and cannot convincingly support the philosophy on which the reduction itself is based. This review supports the approach of researching reasons for encounter as they present to the family doctor, without artificial mind-body metaphors. The medical model is shown to be an incomplete reduction of FM, and the concept of MUS fails to improve this situation. A new model based on a substantial paradigm shift is needed. That model should be the biopsychosocial model, reflected in the philosophical concepts of the International Classification of Primary Care and the value of the patient's 'reason for encounter'. There is more to life than medicine may diagnose, and FM should strive to move closer to the lives of our patients than the medical model alone could allow.

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An international comparative family medicine study of the Transition Project data from the Netherlands, Malta, Japan and Serbia. An analysis of diagnostic odds ratios aggregated across age bands, years of observation and individual practices

Cited by 12 publications

References 16 publications

The interpretation of the reasons for encounter 'cough' and 'sadness' in four international family medicine populations

The interpretation of the reasons for encounter 'cough' and 'sadness' in four international family medicine populations

An international comparative family medicine study of the Transition Project data from the Netherlands, Malta and Serbia. Is family medicine an international discipline? Comparing diagnostic odds ratios across populations

Reasons for encounter and symptom diagnoses: a superior description of patients' problems in contrast to medically unexplained symptoms (MUS)

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